[Alveolar ridge augmentation with hydroxylapatite. A clinical evaluation]. / Hydroxylapatiet-augmentatie. Een klinische evaluatie.

In a retrospective study on the effects of an absolute augmentation of the atrophic alveolar ridge with hydroxylapatite, the patient satisfaction rate with the present denture and the loss in height of the augmentation were assessed. Most patients indicated an improved functioning with their dentures after the operation; nevertheless, the patient satisfaction rate was lower than expected. Additionally a concerned loss in height of the augmentation was demonstrated over the evaluation period of 3.5 years. In selected cases, however, the hydroxylapatite augmentation of the atrophic alveolar ridge may still have its value in preprosthetic surgery.

Regional odontodysplasia: report of three cases.

Regional odontodysplasia is a developmental anomaly of dental tissues with characteristic clinical, radiographic, and histologic appearances. It most commonly affects the maxillary anterior teeth of both the primary and permanent dentition, and occurs in females twice as often as in males. The pathogenesis is unknown. The clinical and histopathologic findings of regional odontodysplasia in three patients are discussed.

[Fractures of the extremely atrophic mandible]. / Fracturen van de extreem atrofische onderkaak.

Fracture treatment of the extremely atrophic mandible is a challenge to the surgeon because of the special problems and complications. A reliable method is the internal fixation technique with multiple split rib grafts. By use of immediate split rib bone grafting secondary revisions and reconstructions may be avoided. The technique and rationale are discussed.

Patient information and patient preparation in orthognathic surgery. The role of an information brochure a medical audit study.

In a retrospective study on 166 patients who had undergone orthognathic surgery, the influence of an information brochure on patient information, satisfaction and dissatisfaction was investigated. Although the use of an information manual was appreciated by the patients and can be recommended, its influence on patient preparation for surgery was poorer than was expected. Verbal information by effective communication between the surgeon and the patient remains the key to patient preparation.

[The single, hollow titanium cylinder implant (I.T.I.)]. / Het holle cilinder titanium implantaat type F (I.T.I.).

In cases of extreme bone loss of the edentulous jaw, nowadays, implants are suitable to create retention and stabilisation for the dentures, next to the wellknown preprosthetic surgical techniques. It is also possible to use this implant as replacement of a single tooth or as abutment for a bridge. The single hollow titanium cylinder implant type F is described. Also the surgical technique for application of this implant is explained. In the period October 1983 till December 1987, 126 implants (39 patients) were placed; eight of them are removed (6%).

The dentist as a plastic surgeon (Hugo Ganzer 1879-1960).

In a short biography, the life and achievements in plastic surgery of the German dentist Hugo Ganzer are described. This pioneer made real contributions in developing tubed pedicle flaps, naso-labial flaps, nasal reconstruction, periorbital reconstruction, jaw reconstruction and cleft palate surgery. His professional career was tragically influenced by his decision not to strive for a medical qualification, being convinced that dentistry alone was a sufficiently sound basis for the performance of facial plastic surgery. Although he found broad recognition, this point of view made it impossible for the formal foundation of the specialty to be attributed to him.

Total mandibular alveolar osteotomy.

Total or posterior mandibular alveolar osteotomy was performed on 12 patients for vertical open bite (2), mandibular alveolar hypoplasia (short-face syndrome) (7), and posterior arch discrepancies (3). Follow-up periods were from nine to 48 months. Most cases showed excellent stability. Permanent damage to the inferior alveolar nerve was found in five of the 21 operated sides (25%). Damage to the tooth pulps was considerable. Two molars had to be removed and apicoectomy or endodontic treatment was carried out on ten others. Although the method is technically difficult, it can be recommended in selected cases because of its excellent stability and predictable end results.

Stable fragment fixation in orthognathic surgery: review of 30 cases.

A method of stable fragment fixation in maxillary and mandibular orthognathic surgery is described. In 30 cases, the follow-up was long enough (one to five years) to promote review of the results. As expected, stability and wound healing were excellent. The method is comfortable for the patient, prevents excessive weight loss, and reduces postoperative morbidity and the length of stay in hospital. The incidence of permanent damage to the mandibular alveolar nerve is the same as with conventional fixation methods. Special attention was given to the possible occurrence of TMJ problems that might result from the condylar rotations. Neither clinical or radiographic evidence of TMJ damage could be established. The method of stable fragment fixation can be especially advocated in bimaxillary and edentulous cases and cases prone to osseous relapse.

Patient information and patient preparation in orthognathic surgery: a medical audit study.

In 110 patients who had undergone various kinds of orthognathic surgery, patient satisfaction was measured by means of a written questionnaire. Ninety-four percent expressed satisfaction, both with regard to total preparation and the final outcome of the surgical procedure itself. Twenty to forty percent of the patients, however, were not properly informed about postoperative complications. On the basis of the deficiencies, indicated in the questionnaire, appropriate written information was developed. In the near future the effect of the recently added information will be investigated.

Early unicystic ameloblastoma: report of case.

The occurrence of an atypical cystic lesion of the mandible in a 13-year-old boy is described. At first, a diagnosis could not be made. The biopsy specimen showed features resembling an ordinary follicular cyst, together with areas in which distinct alterations in the epithelium were noticed. These alterations seemed to be in accordance with findings of Vickers and Gorlin in cases of early or unicystic ameloblastoma. The lesion was treated by enucleation. After almost three years, no recurrence has been noticed. Long-term follow-up care is necessary. The case illustrates the obvious need for meticulous histologic examination of every cystic lesion of the jaw.

Surgical access to multicystic lesions, by sagittal splitting of the lower jaw.

A case is presented of a large, multiloculated primordial cyst in the lower jaw. In treatment planning of the lesion, a hemimandibulectomy had been seriously considered, but seemed to be too agressive a therapy for a non-malignant lesion. However, the recurrence rate of multiloculated cysts made a meticulous enucleation necessary. By employing a sagittal splitting of the right half of the mandible a good surgical access was provided and the cysts could be removed very thoroughly. Recurrence was not observed during a 3 years follow up period.

Anaesthetic experiences in orthodontic surgery.

The anaesthetic experiences and problems have been analysed, based on 100 orthognathic operations. The material includes all kinds of operations; operating time was about 4 hours, except for 8 very extensive procedures, lasting 6--7 hours. The importance of adequate premedication is emphasized. The use of nasal drops for decongestion is especially highly recommended for the prevention of bleeding during nasal intubation. An armoured nasal tube is always used; however, special care must be taken to detect leaks on the cuff. On four occasions the tubes had to be changed because of leaks in the cuff. The most annoying complication was tachycardia, due to: insufficient premedication, insufficient analgesics during operation, or the use of hypotensive drugs. Blood loss was clearly diminished by controlled hypotension. Postoperative vomiting was prevented by the use of a nasogastric tube for the first 6--8 hours. Major complications were not encountered.